Oropharyngeal Cancer Timeline: Surgery Followed by Radiation

When the tissue removed at surgery shows features that raise the chance of the cancer returning, radiation follows surgery, usually starting within about 6 weeks of the operation.

This page is one of six treatment-track timelines for oropharyngeal cancer. The steps before treatment, how a track is chosen and the long-term follow-up schedule are covered on the oropharyngeal cancer treatment timelines page.

Who follows this track

This track begins exactly like surgery alone. The difference is decided after surgery, when the pathologist examines the removed tissue (see understanding pathology results). Radiation is added when the report shows features that raise the chance of the cancer returning, such as more than one involved lymph node, a larger tumor, cancer close to the cut edge, or cancer spreading along nerves or small vessels. When the report shows higher-risk features, such as cancer at the cut edge or growing outside a lymph node, chemotherapy is usually added as well, which is the surgery followed by chemoradiation track.

Before surgery (weeks 0 to 4)

The biopsy, scans, p16 (HPV) result, meetings with the care team, dental check, baseline swallow test, dietitian visit and the tumor board's recommendation are the same as on every track and are described on the overview page.

Surgery and healing (weeks 5 to 10)

• Transoral robotic surgery removes the tumor through the mouth (see throat cancer treatments), usually with a neck dissection. The hospital stay is often 1 to 6 days, and most people start swallowing by the day after surgery.

• About 5 weeks of healing follow before radiation. The pathology report usually arrives 1 to 2 weeks after surgery.

Radiation (about weeks 10 to 16)

• Radiation is given 5 days a week for about 6 weeks. It ideally starts within about 6 weeks of surgery.

• For HPV-positive cancer, studies have shown that many people can safely receive a lower radiation dose after surgery than radiation alone would use.

Side effects and healing

Side effects build gradually during radiation, are usually at their worst in the last week or two of treatment and the 1 to 2 weeks after it ends, and then slowly improve.

• Sore mouth and throat (mucositis): starts around the second week of radiation, peaks near the end, and usually heals within 3 to 4 weeks after radiation ends.

• Swallowing and taste: swallowing trouble peaks late in treatment and improves mostly over the following 6 to 12 months. Taste changes begin a few weeks in, and most taste returns over 3 to 12 months, though some changes can linger.

• Dry mouth: begins early. Modern targeted radiation spares saliva glands, so saliva often partly recovers over 1 to 2 years, though some dryness can last.

• Weight loss and tiredness are common. A temporary feeding tube is needed by some people.

Check-ups and scans

• The follow-up clock starts at the end of radiation, about week 16.

• A PET-CT scan about 12 weeks after radiation checks whether treatment worked. Scans earlier than 12 weeks can give false alarms from healing inflammation.

• Check-ups then follow the usual schedule: every 1 to 3 months in the first year, every 2 to 6 months in the second, every 4 to 8 months in years 3 to 5, then yearly.

Quality of life on this track

Average scores before and after treatment (0 to 100; swallowing 20 to 100; higher is better):

• Overall: 81 before treatment, 78 at 1 year and 84 at 3 years.

• Swallowing: 90 before, 84 at 3 to 6 months and 88 at about 2 years.

• Speech: 93 before and 92 at both 1 and 3 years.

• Mood: 76 before, 85 at 1 year and 89 at 3 years.

These studies did not measure scores in the weeks right after radiation, when side effects peak. The chemoradiation timeline shows how much scores typically dip at the end of radiation-based treatment and how they recover.

Where the numbers come from: the overall, speech and mood scores come from the surgery group of a randomized study that compared surgery with radiation for early oropharyngeal cancer; most people in that group received radiation or chemoradiation after surgery. The swallowing scores come from a large study that reported surgery followed by radiation separately. The questionnaires are described on the quality-of-life questionnaires page.

Long-term care

• Dental visits and possible fluoride treatments continue for life, because of the jaw-healing risk after radiation (osteoradionecrosis).

• A thyroid blood test (TSH) every 6 to 12 months for 3 years checks for hypothyroidism, which radiation to the neck can cause.

• Swallowing exercises and periodic checks continue, and staying tobacco-free lowers the risk of the cancer returning or a new cancer.